White River Junction — There was nothing in particular that Nancy Russell did to trigger the heart attack that nearly killed her. She was simply reading to a group of children at her day care center.

Suddenly Russell felt light headed. Then the paint hit her chest. And before long, she was in an ambulance with a paramedic working to save her. She faded in and out of consciousness as Russell’s daughter and eight-month-old grandchild looked on.

Russell, now 65, came close to dying three times that day in 2004. Doctors later learned that one of her arteries was completely blocked. Another artery was 75 percent closed. Six weeks after narrowly surviving that first attack, Russell suffered another one. She has managed to stay in relatively good health since through careful balance of diet, exercise and medication.

By all appearances, Russell seems like the last person who would get heart disease. She has always eaten plenty of fruits and vegetables, and led an active lifestyle with regular games of tennis, scuba diving and flying private planes. She doesn’t smoke or eat much meat. Also, one might assume that because she’s a woman, heart disease wouldn’t concern her as much as some other afflictions like breast cancer.

However, heart disease kills more women in the U.S. than anything else, causing one out of every four female deaths, according to the Centers for Disease Control and Prevention. In 2009, the latest year for which statistics are available, 292,188 women died from heart disease, more than seven times the number who died from breast cancer.

“It’s a huge issue,” said Christine Medora, a physician at the Hanover Continuity Clinic.

Coronary disease has long been thought of as a man’s problem. Indeed, heart disease is the leading cause of death for men, too. But health advocates and physicians are trying to raise awareness that the disease is not specific to gender, and that more women need to be aware that they are susceptible to heart failure.

Detecting heart disease in women tends to be more difficult, Medora said, with the symptoms often being more subtle than the chest pain men describe.

Several years ago, a 65-year-old female patient of Medora’s complained of feeling more tired than usual. She didn’t feel “as perky on her walks,” Medora said. The woman could have just been out of shape, but a test revealed something more.

“She had multi-vessel coronary artery disease,” Medora said.

Russell was 57 when her first heart attack occurred. She had been taking medication for hypertension since she was in her 30s, but had no idea she was suffering from heart disease. She was not overweight, got annual electrocardiograms to test for problems with her heart. She’d noticed at the time feeling short of breath when out walking, but blamed her asthma.

There is a widely held belief that women don’t exhibit the same symptoms as men, but that’s not necessarily true, said Friederike Keating, a cardiologist at Fletcher-Allen Health Care in Burlington.

Women have many of the same symptoms, but tend to describe them differently, Keating said. For example, when many women experience chest pain, they don’t assign that pain to coming from their heart. They might call it more general chest pain or, as Russell said, feel short of breath.

Also, when they do feel pain, women tend not to call their doctor and instead pick up the phone and dial a friend, Keating said. Doing this, however, can delay detection.

“It’s still more of an awareness gap rather than an actual gap, in terms of the symptoms,” she said.

The factors that cause heart disease, however, are the same for women and men.

Genetics seems to have played a role in Russell’s case. Both of Russell’s parents died of heart attacks and one of her two brothers has hypertension.

Typically, genetics is only part of the reason why a person suffers from heart failure, Keating said.

“Ninety percent of folks with a heart attack do have risk factors,” Keating said.

These include high blood pressure and cholesterol, things that can be tested and used to figure out a person’s chances of having heart problems later in life. Smoking is another major risk factor, according to the CDC.

Lifestyle is important, which is why Keating and Medora counsel patients on diet and exercise regularly.

Being overweight doesn’t guarantee that a person will develop heart disease, but it can weaken their health in other ways, such as leading to diabetes or high cholesterol, that do contribute to heart disease, Keating said.

For anyone dealing with weight problems and worried about heart disease, the first goal should be to not gain any more weight, Keating said. The second goal is to move every day.

Ideally, someone would exercise to the point where they are out of breath, Keating said, but “the most important step is that first step off the couch.”

Russell never had that problem. She was something of a thrill seeker as a sky diver, a rescue scuba diver and even had driven race cars.

It was while she was walking gently on a treadmill, however, that her second heart attack struck.

She no longer scuba dives or flies airplanes because of her medication, though she swims regularly. Other than switching from whole milk to drinking skim, she hasn’t changed her diet much and still eats plenty of fruits and vegetables, and not much meat.

Her advice to other women is to act conservatively when something is wrong. Take chest pain seriously and, even if there’s the slightest chance it could have been a heart attack, call 911 emergency rather than get in the car and drive to the hospital.